Death Ignores the Golden Hour The Argument for Mobile, Farther-Forward Surgery(Need link)

Brian C. Beldowicz, Michael Bellamy, Robert Modlin

MILITARY REVIEW 2020; March-April 2020: 39-48

Although the footprint of medical resources has significantly contracted in recent years, the geography of ongoing operations has not. As a result, at-risk soldiers find themselves reliant on more tenuous limbs of medical support, far removed from the meticulously orchestrated medical evacuation (medevac) rings once deemed an operational imperative. The first hour after the occurrence of a traumatic injury is considered the most critical for emergency stabilization of a casualty. This “Golden Hour” concept establishes a serviceable standard for the distribution of fixed medical resources supporting areas of operation. However, the Golden Hour paradigm is insufficient for large-scale combat operations (LSCO), specifically when planning medical support for those offensive operations associated with the highest risk to force or those conducted in movement-restricted environments where timely medevac is not guaranteed. In order to provide ground force commanders with options for risk reduction consistent with best medical practice, medical planning will need to recalibrate from the prevailing Golden Hour paradigm to a more deliberate mission support model. Planners must consider operational importance, asymmetric distribution of risk to force, and available surgical assets’ capacity to influence preventable combat mortality and improve the efficiency of the casualty care system.